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Localism in the NHS Quasi-Market

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  • M Exworthy

    (Institute for Health Policy Studies, University of Southampton, Southampton SO17 1BJ, England)

Abstract

The organisation of the British National Health Service (NHS) has been hierarchical and based on defined geographical areas [for example, health authorities (HAs)]. These areas have formed the basis of local health systems in which the social relations between individuals and agencies were contained within the territorial boundaries of the respective organisation and thereby engendered, in most eases, a degree of trust and cooperation. The introduction of quasi-market mechanisms in the NHS in 1991 inferred that the social relations between local actors were not essential and hence transactions could be independent of them. Economic transactions need not therefore be confined to the local area. However, social relations have continued in various forms since the quasi-market was implemented as manifested through, inter alia, the persistence of localism in the market. Localism is evident, for example, in HA expenditure, which remains highly skewed towards local providers and, it is argued here, is a function of social relations between purchaser and providers. Localism and the social relations associated with it exemplify the relational nature of the quasi-market, which has shown signs of moves towards longer term contracts, risk-sharing and cooperation (rather than competition). Thus, by noting the persistence of localism and social relations, the author suggests that the quasi-market has yet to evince the paradigm shift intended by the 1991 reforms.

Suggested Citation

  • M Exworthy, 1998. "Localism in the NHS Quasi-Market," Environment and Planning C, , vol. 16(4), pages 449-462, August.
    • Handle: RePEc:sae:envirc:v:16:y:1998:i:4:p:449-462
    DOI: 10.1068/c160449
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    References listed on IDEAS

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    1. Dranove, David & Shanley, Mark & White, William D, 1993. "Price and Concentration in Hospital Markets: The Switch from Patient-Driven to Payer-Driven Competition," Journal of Law and Economics, University of Chicago Press, vol. 36(1), pages 179-204, April.
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    Cited by:

    1. Exworthy, Mark & Frosini, Francesca, 2008. "Room for manoeuvre?: Explaining local autonomy in the English National Health Service," Health Policy, Elsevier, vol. 86(2-3), pages 204-212, May.
    2. Castelli, Adriana & Jacobs, Rowena & Goddard, Maria & Smith, Peter C., 2013. "Health, policy and geography: Insights from a multi-level modelling approach," Social Science & Medicine, Elsevier, vol. 92(C), pages 61-73.
    3. Jones, Lorelei & Exworthy, Mark & Frosini, Francesca, 2013. "Implementing market-based reforms in the English NHS: Bureaucratic coping strategies and social embeddedness," Health Policy, Elsevier, vol. 111(1), pages 52-59.

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